双动脉的困境:TAVI还是SAVR? 来自NOTION-2试验的见解
1Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India.
Indian journal of thoracic and cardiovascular surgery
|August 19, 2024
概括
在NOTION-2试验中发现,在低风险患者,特别是双门患者中,透管大动脉植入 (TAVI) 的不良事件比外科大动脉置换 (SAVR) 高.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 跨导管大动脉植入 (TAVI) 越来越多地用于大动脉狭窄.
- 低风险患者传统上接受了手术性大动脉置换 (SAVR).
- 现有有限的数据比较TAVI和SAVR在年轻,低风险个体,包括双主动脉.
研究的目的:
- 在低风险患者群体中比较TAVI与SAVR的安全性和有效性.
- 为了特别评估年轻患者和双上大动脉患者的结果.
主要方法:
- 北欧大动脉干预-2 (NOTION-2) 试验是一项随机对照试验.
- 370名低风险患者被随机分配到TAVI或SAVR.
- 结果在1年的随访后进行了评估.
主要成果:
- 在总体队列中,复合初级终点发生在TAVI (10.2%) 与SAVR (7.1%) 相比较频繁.
- 这种差异在双主动脉患者中更为显著 (TAVI 14.3%与SAVR 3.9%).
- 一年后死亡或致残性中风的风险是TAVI的三倍.
结论:
- 在低风险患者中,TAVI与1年后SAVR相比,TAVI与更高的不良事件率有关.
- 在患有双主动脉的患者中,TAVI显示出特别不利的风险概况.
- 对于某些低风险患者,尤其是双门患者,SAVR仍然是首选的选择.
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